Psoriasis Flashcards
Psoriasis
- common chronic skin disorder
- multifactorial pathophysiology
Features of psoriasis
- red, scaly patches
- nail signs: pitting, oncholysis
- arthritis
Pathophysiology of psoriasis
multifactorial
- genetic (HLA-B13)
- immunological (abnormal T cell)
- environmental (worsened - trauma, triggered - infection)
Subtypes of psoriasis
- plaque
- flexural
- guttate
- pustular
Complications of psoriasis
- psoriatic arthropathy
- increased incidence of: metabolic syndrome, CVD, venous thromboembolism
- psychological distress
Nail changes seen in psoriasis
- pitting
- onycholysis (separation from nail bed)
- subungual hyperkatosis
- loss of nail
Exacerbating factors for psoriasis
- trauma
- alcohol
- drugs
- withdrawal systemic steroids
- streptococcal infection (guttate)
Drugs that exacerbate psoriasis
- beta blockers
- lithium
- antimalarials (chloroquine)
- NSAIDs
- ACE-I
First-line management of chronic plaque psoriasis
- potent corticosteroid once daily
- vitamin D analogue once daily
- up to 4 weeks initial treatment
Second-line management of chronic plaque psoriasis
if no improvement after 8 weeks:
- add vitamin D analogue 2x daily
Third-line management of chronic plaque psoriasis
if no improvement 8-12 weeks offer…
- potent corticosteroid x2 daily 4/52
- coal tar preparation once or twice daily
Secondary care management of chronic plaque psoriasis
- phototherapy (UVB 3/7)
- systemic therapy (oral methotrexate, systemic retinoids)
Management of scalp psoriasis
- potent topical corticosteroids x1 daily 4/52
Vitamin D analogues
- e.g. calcipotriol, calcitriol
- reduce cell division and differentiation -> reduced epidermal proliferation
- minimal side effects, use long-term
- do not reduce erythema
